Itinerário terapêutico dos pacientes acometidos por Acidente Vascular Cerebral: estudo de Coorte

Abstract

Introduction: The therapeutic itinerary of patients affected by Stroke, within the context of the Unified Health System (SUS), exposes them to unpleasant experiences, resulting in health impacts and avoidable deaths that are often not prevented due to a lack of organized care network. Stroke is considered an acute neurological dysfunction, classified as hemorrhagic or ischemic. Objective: To compare the therapeutic itinerary in accessing care for patients affected by stroke in hospitals from the interior and the capital of the State of Sergipe. Materials and Methods: Prospective cohort study, carried out from August 2022 to January 2023, in all public hospitals that had a neuroimaging service in the State of Sergipe. The data collection instrument sought sociodemographic characterization, timeline, factors influencing patients’ medical care-seeking, medical history, antecedents, admission physical examination, diagnosis, management, and 30-day outcome after the stroke. Approved by the ethics committee under opinion number 5,455,345. The data were exported to R software Core Team 2022. After being encoded and tabulated, they were analyzed using descriptive statistics. The hypothesis of independence was tested using Pearson’s Chi-square and Fisher’s Exact tests. Crude and adjusted odds ratios were estimated through logistic regression. Results: The study included 159 patients attended in the interior and 91 in the capital, with a median age in the capital of 66 years (SD: 55.5-75), and in the interior of 72 years (SD: 60-82), with a higher incidence of female patients. Higher incidence of ischemic strokes (P < 0.002). In the time variable, it was dichotomized into two periods: decision time and detection time. Regarding decision time between the onset of signs and symptoms until the decision to call for transportation, it was observed that patients with ischemic stroke attended in the interior take three times longer (P = 0.002). In cases of hemorrhagic stroke, the interior takes ten times longer (P = 0.028). The detection time, between CT scan and stroke detection, was five times longer in the interior (P < 0.001) for ischemic stroke cases. In cases of hemorrhagic stroke, the interior had 1.4 times longer detection time. In the evaluation by the neurologist, in the interior, for ischemic stroke cases, 76.6% vs. 78.3% for hemorrhagic stroke, while in the capital, 100% were evaluated in both types of stroke (P < 0.001). Regarding therapeutic management, 100% of patients attended in the interior received clinical treatment, while in the capital, it was 90% (P < 0.001). The analyzed outcomes were in-hospital mortality: in the capital, ischemic stroke cases had 20% vs. 42.9% for hemorrhagic stroke, while in the interior, ischemic stroke cases had 22.1% vs. 28.6% for hemorrhagic stroke. Mortality within 30 days post-stroke in the capital for ischemic stroke cases: 20% vs. 47.6% for hemorrhagic stroke, while in the interior for ischemic stroke cases: 25.5% vs. 28.6% for hemorrhagic stroke. Regarding functionality, most patients presented disabilities, with Rankin scale scores ranging from 3 to 5. Conclusion: The therapeutic itinerary of patients attended in the interior has a longer time interval, from the onset of signs and symptoms to the diagnostic conclusion.